Instrument for suturing esophagus to intestine or stomach



July-6, 1965 M. G. AKHALAYA ETAL 3,193,165

INSTRUMENT FOR SUTURING ESOPHAGUS TO INTESTINE OR STOMACH Filed Aug. 27, 1962 INVENTOR. j /I/f//r/m/L G. ,4K/VH1. .4 n4

v l, ...ATTORNEYS United States Patent O 3,193,165 INSTRUMENT FOR SUTURING ESOIHAGUS T INTESTINE GR STMACH Mikhail Gueorguievich Akhalaya, Sukliumi, ulitsa Lenina 22, Apt. 7; Viacheslav Sergeevich Kasoolin, Bolshaya Pochtovaya ulitsa 18/20, korpus 1, Apt. 47; Gueorgui Vasilievich Astafiev, the 2nd Novo-Ostanhinsiraya ul. 8a, Apt. 33; Svetoslav llvanovich Babkiu, the 1st Charemusllkinskaya ulitsa 11/9, korpus 1, Apt. 16; Alexander Nesterovich Burtsev, Donetsk oblastnoi, ulitsa Artjema 84, Apt. 16; Tatyana Viadimirovna Kalinina, Chasovaya ulitsa 27/ 12, Apt. 22; and Guam-gui lesitevich Tatshvili, Tbilisi, Ditlubiiskaya uiitsa 4; al1 of Moscow, U.S.S.R.

Filed Aug. 27, 1962, Ser. No. 222,987 Claims. (Cl. 227-8) This invention relates to surgical instruments and more particularly to such an instrument for suturing the esophagus to the intestine or stomach by utilizing metallic staples to provide a circular suture.

At present when it is necessary to attach the end of the esophagus to the lateral wall of the intestine or to the stomach, it is customary to perform this operation manually by the use of a needle and suturing thread. Such an operation requires from twenty to twenty-four stitches and, therefore, the quality of the suture depends primarily on the skill of the surgeon.

Suturing devices have previously been proposed for facilitating this operation, but these have not proved satisfactory, in that undesirable complications, such as necrosis etc., have resulted and furthermore, these devices only facilitate the formation of a linear suture and cannot be utilized for forming a circular suture, such as is necessary in attaching the end of the esophagus to the intestinal wall or to the wall of the stomach.

It is accordingly an object of the invention to provide a surgical instrument for suturing the end of the esophagus to Vthe wall of the intestine or to the wall of the stomach by the use of a circular series of metal staples.

A further object of the invention is the provision of a surgical instrument for suturing the end of the esophagus to the wall of the intestine or to the Wall of the stomach, which instrument may be conveniently manipulated by one hand of the user to place a circular series of staples and clinch the same to provide a circular suture.

A still further object of the invention is the provision of a surgical instrument for suturing the end of the esophagus to the Wall of the intestine or the wall of the stomach, which instrument may be conveniently manipulated to clamp the tissues of the two organs in juxtaposition and thereafter insert and clinch a circular row of stapes to provide a circular suture and also to cut away excess tissue within the circular row of staples.

Another object of the invention is the provision of a surgical instrument for suturing the end of the esophagus to the wall of the intestine or to the Wall of the stomach, which instrument is provided with means for preventing inadvertent operation thereof.

A further object of the invention is the provision of a surgical instrument for suturing the esophagus to the wall of the intestine or the wall of the stomach, which instrument may be conveniently inserted and withdrawn through a single incision in the wall of the intestine or the wall of the stomach.

A still further object of the invention is the provision of a surgical instrument for suturing the esophagus to the wall of the intestine or to the wall of the stomach, which instrument may be conveniently disassembled for cleaning purposes or for replacement of parts, such instrument also being suitable for sterilization.

Further objects and advantages of the invention will be lCe apparent from the following description taken in conjunction with the accompanying drawing wherein:

FIG. l is a side elevational view with parts broken away and in section for greater clarity and showing the overall construction of the surgical instrument of this invention;

FIG. 2 is a sectional view taken substantially on the line 2 2 of FIG. l;

FIG. 3 is a sectional view taken substantially on the line 3 3 of FIG. l;

FIG. 4 is a fragmentary sectional view taken substantially on the line 4 4 of FIG. l;

FIG. 5 is a sectional view taken substantially on the line 5 5 of FIG. l;

FIG. 6 is a sectional view taken substantially on the line 6 6 of FIG. l;

FIG. 7 is a fragmentary sectional View taken substantially on the line 7 7 of FIG. l; and

FIG. 8 is a fragmentary sectional view to an enlarged scale and showing the manner of using the instrument of this invention to suture the end of the esophagus to a wall of the intestine or stomach and the manner in which excess tissues are cut away after completion of the suturing operation.

With continued reference to the drawing, there is shown a surgical instrument constructed in accordance with this invention `and which may well comprise an elongated tubular body 1d which is provided at the forward end with a circular series of pockets 11 which are open 'at opposite ends and each of which pockets serve to receive a staple with the prongs of such staple projecting toward the forward end of the body 1t). Slidably mounted within the body `1t? is a member 12 which is provided at the forward end thereof with Ia circular series of staple ejecter fingers 13 and such fingers 13 enter the pockets 11 from the rear and are slidably received therein. A knife 14 is mounted on the member 12 and a circular cutting edge 15 is provided on the forward end of the knife 14.

A tubular push rod 16 is xed to the member -12 and the push rod `16 extends rearwardly within the body 10. A washer 17 engages the rear end of the body 10 and the washer 17 is provided with a recess 18 for slidably receiving the rear end of the push rod 16. The recess 18 terminates in a shoulder 19 which serves to engage the rear end of the push rod 16 and limit rearward movement thereof. The washer 17 and rear end of the body `1t) are provided with interlocking means 20 for orienting the washer `17 with respect to the body 10. A clamping nut 21 is threadedly received on the rear end of the body 10 and, as clearly shown in FIG. 1, the nut 21 engages the washer 17 to removably secure `the same in place on the rear end ofthe body 1t).

An adjusting rod 22 extends through and is slidably received in the push rod 16 and secured to the forward end of the adjusting rod 22 is a pilot head 23 having a generally hemispherical forward end surface 24. The pilot head 23 is provided on the rear side thereof with a circular series of recesses 25, as clearly shown in FIG. 6, and such recesses are disposed in alignment with the pockets 11 in the body 10 and the recesses 25 serve to provide anvils for clinching staples ejected from the pockets `11 in a manner to be later described. The pilot head 23 is also provided with a rearwardly opening annular recess 26 which serves to removably receive a pad 27 which may well comprise a disk of semi-hard plastic material or other lsuitable material and such pad 27 provides an abutment for engagement with the cutting edge 15 of the knife 14 thereby serving to prevent damage or undue dulling of such cutting edge.

The adjusting rod 22 extends rearwardly through an aperture 28 in the washer 17 and such aperture 2S may be non-circular in form or may be provided with keys 29 as -shownin FIG. 2 'which are slidably received in splines or grooves 3% in the adjusting rod`22 and which serve to prevent relative rotation between the rod 22 and the'washerV 17.

The rear end of the adju-sting rod 22 is threaded, as at 31, and such threads are threadedly engaged lby an adjusting nut 32 which is rotatably mounted on a cylindrical portion `3? of the clamping nut 21. A set screwY S4 received in the 'adjusting "nut '32V and havingY Va portion engagingfa groove 35 in the clampinglnut l21V serves to removably retain the adjusting nut 32 on the clamping nut 21 while permitting relative rotation therebetween to adjust the adjusting rod 22 longitudinally for a purpose which will presently appear. e

A bracket 36 is Ysecured to the body 1li .and fixed to is a fixed handle 37. A movable handle 33 Vis provided .ing thel instrument into the intestine or stomach, the adjusting nut 32 is adjusted to space the pilothead 23 `from Y the forward end of the body 110 and aft-er rmoving the pilot Iin FIG. 8 with suchend disposed within the rearwardly VY the bracket 36 and projecting laterally from the body 1.@

opening recess 26 inthe .pilot head 23. The adjusting nut 32is now operated t-o move the pilot head 23 toward the forward end of the body -10 Whieh'serves to clamp the tissues of the wall a of the intestine or stomach and the wal-l b of the esophagus-together as clearly shownin FIG. V8. At thisr time the linger engaging portion 49 of with a pivot pin 39 which is removably received in slots-l o 40 in thev brackets-36- and serves to Vpivotally and removably mount the movable handle 38 Yon the bracket,

36. The movable handle 3S is also provided with a forked end 41 which Vis received between spaced abut` ments 4Z and 43 on .the pushV rod 16 whereby movement of the movable handlerSS results in moving the push rod 16 longitudinally. A suitable spring 44 is provided-on the movable handle V38 and the spring i4 engages a .pro-

jection 45von the fixed handle 37 to urge the movable `is movable from one positionK in engagement `with a stop member 56 to a second position K -vin engagement Vvabove described surgical instrumenta device which may with a second stop member 571. As shown in FIG. 7,1' the iinger engaging lever 4% may be provided with a detent 52 for engaging in( recesses 53 lin the movable handle 38 to releasably retain the linger engaging portion 49 in either'the position K or the position K. With'the finger'engaging portion 49 in the position K as shown in FIG. 1, the nosev portion 4S engages a projection 54 on the fixed handle 37, and prevents movement ofthe movy able handle 38 toward Ithe fixed handle 57. kialowever, upon movement-of. the yfinger engaging portion 49 to the position K', the nose portion 48 `will be moved away sul-tain the fingers y13 ejecting staples from .the pockets 171 and t-hestaples SS are forced Ythrough the-wall a of the intestine or st-omac-hand the wall b of the esophagus and ar-e clinched inposition by engaging in the anvil recesses 25S in the rea-r side of the pilot head I23. At the-same time, the knife :14 moves 'forwardly and lthe circular edge l15 .thereof Imoves to the position shown in FG. 8 to cut the excess tissues inwardly of the rowV of staples 55 to permit removal of such excess tissues and also to provide an opening through which the pilot head of the instrument is removed after manipulation of the adjusting nut 32 to relieve the clamping Vpressure between the rear side of the pilot head 23 and the forward end of the body 10.

it will thus be yseen that there has been provided by the be conveniently'utilized to provide a circular suture between the'end of the esophagus andthe wall of the intestine or the Wall of the stomach, thev sutu-ring being Y completed in a single'rapidloperation land obviously, such operation does not 'require the high degree of skill which is necessaryin manually suturing the esophagus to the wall of the intestine or the Ywall' of the stomach.

Suitable :safeguards have been Aprovided to prevent inadvertent operation lof the instru-ment and Ito provide for suitable and foolproof operation thereof and the instrul vrnentof this invention serves to materially simplify what in the condition shown in FIGQI land it will be noted that by reason `of the interlocking meansZ between the Washer 17 vand -the body 10 andvfurtherfbyV reason of the engagement of the keys 29`and Vsplines 30 thatradjustf positioned in each pocket lll'and'that theentire instru-V y ment has Vbeen suitably sterilized.' While the inter-engaging means between the washer 17 and Vadjusting rod 22 has been shown and described as a splined connection,

obviously any'non-circular formation ofthe aperture in.'

heretofore khas been an extremely difficult and dangerous operation.V Y

lt will beV obvious to those skilled in lthe art that various changes may IbeV made 4in the invention Without departing from the spirit and scope thereof and therefore the inventionV isnot limitedV by that which is shown in the Ydrawing ,and described in the specilication, but only as indicated in the appended claims.

ceived injsaid body, staple ejec-t'er fingers onrsaid member,

" Ysaid fingers entering said pockets from the rear, a knife the Washer 17 and a complementary formation of theV provide mounted on said member and having acircular cutting edge at the forward end, a tubular push rod fix-ed to said member .and extending rearwardly within said body, a washer engaging .the rear end 'ofV said body Vand having a recesswsl-idably receiving the rear endy Vof' said push rod, a shoulder in said recess to limit rearward movement of said push rod, interlocking means on said body and washer to prevent relative rotation therebetween, a clamping nut has been introduced'intothe intestine or stomach through e Y 'a suitable incision in the wall q thereof Vand the wall a has previously been punctured at a point ci where it is desired to attach the end'of the esophagus.v Prior to insertthreadedly :received on the rear end of said body and engaging said washer to .removably retain saidwasher in place, Aan adjusting-rod extending through said push rod7 apilot head fixed to the forward end of said adjusting rod,

said head having a circular series of recesses in alignment with said pockets and providing anvils for clinching staples ejected from said pockets, said head having an angular recess opening rearwardly, a removable pad in said annular recess for engaging the cut-ting edge of said knife, a non-circular aperture in said washer, said adjusting rod n extending through said aperture and having a complementary non-circular portion engaging the wall of said recess to permit sliding movement of said adjusting rod and orient said head, a cylindrical portion on said nut, an adjusting nu-t rotatably received on said cylindrical portion and lthreadedly engaging said adjusting rod to adjust the axial position of said head with respect to said body, .a fixed handle extending laterally from said body, spaced abutments on said push rod, a movable handle pivo-talrly mounted on said body and a forked end on said movable handle received between said abutments, whereby upon operation of said movable handle said push rod will move said fingers forwardly to eject staples from said pockets and clinch the same and will move sai-d cutting edge into yengagement with said pad.

2. A surgical instrument as defined in claim 1 in which stop means is provided for .preventing inadvertent movement of said movable handle.

i3. A surgical instrument as defined in claim Z in which said stop means comprises a lever pivotally mounted on said movable handle and movable between two positions, a nose portion lon said lever for engaging said xed handle in one position to prevent movement of said movable handle and inthe other position to permit such movement and detent means for releasably retaining said lever in either posi-tion.

4. A surgica-l instrument as defined in claim ll in which spring means is provided for returning said movable handle .to original position.

5. A surgical instrument as defined in claim 1 in which said movable handle is removable to permit disassembly of said instrument.

6. A surgical instrument as dened in claim 1 in which means is provided for rotatably and removably retaining said adjusting nut on lthe cylindrical por-tion of said clamping nut.

7. A surgical instrument as defined in claim 1 in which said pad comprises a semi-hard plastic disk.

8. A surgical instrument as ldefined in claim 1 in which the forward end yof said pilot head is substantially hemispherical.

9. A surgical instrument as defined in claim 1 in which said knife is removable to permit replacement.

It). A surgical instrument for su-turing the esophagus to the intestine or stomach, said instrument comprising an elongated tubular body, the forward end of said body having a circular series of pockets open at opposite ends for receiving a staple in each pocket, a member slidably received in said body, staple ejecter ingers on said member, said fingers `entering .said pockets from the rear, a knife mounted on said member and having a circular cutting edge at the forward end, a tubular push rod fixed to said member and extending `rearwardly within said body, a washer engaging ythe rear end of said body, means on said washer to limit rearward movement of said push rod, interlocking means on said body and washer to prevent relative rotation therebetween, a clamping nut threadedly received on the rear end of said body and engaging said washer to removably retain said washer in place, an adjusting rod extending `through said push rod, a pilot head fixed to `the forward end of said adjusting rod, said head having a circular series of recesses in alignment with said pockets and providing anvils for clinching staples ejected from said pockets, said head having an annular recess opening rearwardly, a removable pad in said annular recess for engaging Ithe cutting edge of said knife, a non-circular aperture in said washer, said adjusting rod extending through said aperture and having a complementary non-circular portion engaging the wall of said recess .to permit sliding movement of said adjusting rod and orient said head, a cylindrical Iportion on said nut, an adjusting nut rotatably received on said cylindrical por- .tion and threadedly engaging said adjusting rod to adjust the axial position of said head with respect to said body, a tix-ed handle extending laterally from said body, spaced abutments on said push rod, a movable handle pivotally mounted on said body and .a forked end on said movable handle received between said abutments, whereby upon operation of .said movabl-e handle said push rod will move said fingers forwardly to eject staples from said pockets `and clinch the same and will move said cutting edge into engagement with said pad.

No references cited.

GRANVILLE Y. CUSTER, IR., Primary Examiner. 

1. A SURGIAL INSTRUMENT FOR SUTURING THE ESOPHAGUS TO THE INTESTINE OR STOMACH, SAID INSTRUMENT COMPRISING AN ELONGATED TUBULAR BODY, THE FOWARD END OF SAID BODY HAVING A CIRCULAR SERIES OF POCKETS OPEN AT OPPOSITE ENDS FOR RECEIVING A STAPLE IN EACH POCKET, A MEMBER SLIDABLY RECEIVED IN SAID BODY, STAPLE EJECTERFINGERS ON SAID MEMBER, SAID FINGERS ENTERING SAID POCKETS FROM THE REAR, A KNIFE MOUNTED ON SAID MEMBER AND HAVING A CIRCULAR CUTTING EDGE AT THE FORWARD END, A TUBULAR PUSH ROD FIXED TO SAID MEMBER AND EXTENDING REARWARDLY WITHIN SAID BODY, A WASHER ENGAGING THE REAR END OF SAID BODY AND HAVING A RECESS SLIDABLY RECEIVING THE REAR END OF SAID PUSH ROD, A SHOULDER IN SAID RECESS TO LIMIT REARWARD MOVEMENT OF SAID PUSH ROD, INTERLOCKING MEANS ON SAID BODY AND WASHER TO PREVENT RELATIVE ROTATION THEREBETWEEN, A CLAMPING NUT THREADEDLY RECEIVED ON THE REAR END OF SAID BODY AND ENGASING SAID WASHER TO REMOVABLY RETAIN SAID WASHER IN PLACE, AN ASJUSTING ROD EXTENDING THROUGH SAID PUSH ROD, A PILOT HEAD FIXED TO THE FORWARD END OF SAID ADJUSTING ROD, SAID HEAD HAVING A CIRCULAR SERIES OF RECESSES IN ALIGNMENT WITH SAID POCKETS AND PROVIDING ANVILS FOR CLINCHING STAPLES EJECTED FROM SAID POCKETS, SAID HEAD HAVING AN ANGULAR RECESS OPENING REARWARDLY, A REMOVABLY PAD IN SAID ANNULAR RECESS FOR ENGAGING THE CUTTING EDGE OF SAID KNIFE, A NON-CIRCULAR APERTURE IN SAID WASHER, SAID ADJUSTING ROD EXTENDING THROUGH SAID APERTURE AND HAVING A COMPLEMENTARY NON-CIRCULAR PORTION ENGAGING THE WALL OF SAID RECESS TO PERMIT SLIDING MOVEMENT OF SAID ADJUSTING ROD AND ORIENT SAID HEAD, A CYLINDRICAL PORTION ON SAID NUT, AN ADJUSTING NUT ROTATABLY RECEIVED ON SAID CYLINDRICAL PORTION AND THREADEDLY ENGAGING SAID ADJUSTING ROD TO ADJUST THE AXIAL POSITION OF SAID HEAD WITH RESPECT TO SAID BODY, A FIXED HANDLE EXTENDING LATERALLY FROM SAID BODY, SPACED ABUTMENTS ON SAID PUSH ROD, A MOVABLE HANDLE PIVOTALLY MOUNTED ON SAID BODY AND A FORKED END ON SAID MOVABLE HANDLE RECEIVED BETWEEN SAID ABUTMENTS, WHEREBY UPON OPERATION OF SAID MOVABLE HANDLE SAID PUSH ROD WILL MOVE SAID FINGERS FORWARDLY TO EJECT STAPLES FROM SAID POCKETS AND CLINCH THE SAME AND WILL MOVE SAID CUTTING EDGE INTO ENGAGEMENT WITH SAID PAD. 